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NPI Code Detail

MEDICARE: JORGE CASTILLON

MEDICARE: JORGE CASTILLON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorCADC 00752NV
2225400000XRehabilitation Practitioner
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1255613931
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE CASTILLON
Provider Business Mailing Address
First Line : 1640 E FLAMINGO RD
Second Line : 100
City : LAS VEGAS
State : NV
Zip : 89119-5249
Country : US
Telephone Number : 702-369-4357
Fax Number : 702-369-4089
Provider Business Practice Location Address
First Line : 1640 E FLAMINGO RD
Second Line : 100
City : LAS VEGAS
State : NV
Zip : 89119-5249
Country : US
Telephone Number : 702-369-4357
Fax Number : 702-369-4089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2011
Last Update Date : 05/22/2014

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Directions to “ JORGE CASTILLON ” Practice Location

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